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Billing secondary ins./taking adjustments

  1. Question Billing secondary ins./taking adjustments
    Medical Coding Books
    I have a question and was wondering if anyone could help.
    We billed a patients primary insurance (which we par with) and took the contractual adjustment. The secondary insurance came back and paid the amount we contractually adjusted off from the primary insurance. I'm not sure if it is legal to void the adjustment and accept the secondary ins. pymt or should I refund the money to the secondary insurance payor?

    Thanks for your help in advance!
    Shelli

  2. #2
    Default
    Quote Originally Posted by shelli0951 View Post
    I have a question and was wondering if anyone could help.
    We billed a patients primary insurance (which we par with) and took the contractual adjustment. The secondary insurance came back and paid the amount we contractually adjusted off from the primary insurance. I'm not sure if it is legal to void the adjustment and accept the secondary ins. pymt or should I refund the money to the secondary insurance payor?

    Thanks for your help in advance!
    Shelli
    This has happened to our office in the past, and we have been refunding the 2ndary payor and in some cases they are sending the money back stating the do not do coordination of primary insurance payment, and in other cases some insurances say "thanks" and keep the refund.

    I would try sending it back first to see what happens, then that way you can keep track of the insurances who do not coordinate on the primary carriers payments.

    Good luck,
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  3. Default
    I usually call the secondary insurance to find out if they coordinate benefits. If they do, then I find out their policy on payment. Some secondary insurances allowed is higher than the primay's insurance allowed, if the secondary is not a supplemental policy is all right to adjust. If the secondary insurance is a supplemental policy (coordinate benefits), then I refund the secondary payment. A secondary policy is not always supplemental to the primary. Make sure too, that the primary payment was referenced correctly, this is usually found next OA23 or CO23 on the remits. I have lots of cases that the secondary did not process the primary payment correctly.

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